Responsibility for Vaccination

Timing of Vaccination

Household Members (See Table 1)

Table 1. Safety of Administration of Live Vaccines to Contacts of Immunocompromised Persons

International Travel

Specific Vaccinations

Special Populations

Document Overview

Design and created by Guideline Central in participation with the Infectious Diseases Society of America.

Vaccination of the Immunocompromised Host

Infectious Diseases Society of America

Publication Date: Dec 4, 2013

Page Last Updated: May 5, 2026

Grading Table

Category/Grade	Definition
Recommendation
SR - Strong	Clear desirable or undesirable effects
WR - Weak	Desirable and undesirable effects closely balanced or uncertain
Quality of Evidence
H - High	Consistent evidence from well-performed RCTs or exceptionally strong evidence from unbiased observational studies
M - Moderate	Evidence from RCTs with important limitations or moderately strong evidence from unbiased observational studies
L - Low	Evidence for ≥1 critical outcome from observational studies, from RCTs with serious flaws or from indirect evidence
VL - Very Low	Evidence for ≥1 critical outcome from unsystematic clinical observations or very indirect evidence
GRADE	Implication	Comment
SR-H	Applies to most patients in most circumstances	Further research is unlikely to change estimate
SR-M		Further research may change estimate
SR-L
SR-VL	Estimate of effect for at least one critical outcome is very uncertain
WR-H	The best action may differ depending on circumstances or patients or societal values	Further research is unlikely to change estimate
WR-M	Alternative approaches likely to be better for some patients under some circumstances	Further research may change estimate
WR-L	Other alternatives may be equally reasonable	Further research may change estimate
WR-VL	Other alternatives may be equally reasonable	Any estimate of effect, for at least one critical outcome, is very uncertain

For the complete GRADE Strength of Recommendations and Quality of the Evidence Table, visit the IDSA website: http://www.idsociety.org/Guidelines_Other/

Document Overview

Document Title: Vaccination of the Immunocompromised Host

Authoring Society: Infectious Diseases Society of America

Document Publication Date: Dec 4, 2013

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: academic.oup.com/cid/article/58/3/e44/336537?searchresult=1

Source Citation: Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host. Clin Infect Dis. 2014;58(3):e44-100.

Supplemental Implementation Resources

Quick-Reference Guide

Document Scope, Criteria, and Use Cases

Document Objectives: These guidelines were created to provide primary care and specialty clinicians with evidence-based guidelines for active immunization of patients with altered immunocompetence and their household contacts in order to safely prevent vaccine-preventable infections. They do not represent the only approach to vaccination. Recommended immunization schedules for normal adults and children as well as certain adults and children at high risk for vaccine-preventable infections are updated and published annually by the Centers for Disease Control and Prevention (CDC) and partner organizations. Some recommendations have not been addressed by the Advisory Committee on Immunization Practices (ACIP) to the CDC or they deviate from recommendations. The goal of presenting these guidelines is to decrease morbidity and mortality from vaccine-preventable infections in immunocompromised patients. Summarized below are the recommendations made by the panel. Supporting tables that provide additional information are available in the electronic version. The panel followed a process used in the development of other Infectious Diseases Society of America guidelines, which included a systematic weighting of the quality of the evidence and the grade of the recommendation. The key clinical questions and recommendations are summarized in this executive summary. A detailed description of the methods, background, and evidence summaries that support each recommendation can be found in the full text of the guidelines.

Scope: Prevention

Diseases/Conditions (MeSH)

D016867 - Immunocompromised Host

D007114 - Immunization

D016867 - Immunocompromised Host

D007114 - Immunization

Keywords: asplenic, immunization, immunocompromised, immunodeficiency, immunosuppression, vaccination

Target Patient Population: patients with altered immunocompetence

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Infant, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Who is responsible for vaccinating immunocompromised patients and members of their household?
When should vaccines be administered to immunocompetent patients in whom initiation of immunosuppressive medications is planned?
Which vaccines can be safely administered to individuals living in a household with immunocompromised patients, and what precautions should immunocompromised patients observe after vaccination of household members?
Which vaccines can be administered to immunocompromised patients contemplating international travel?
Should immunocompromised patients or those scheduled to receive immunosuppressive therapy receive varicella vaccine (VAR)?
Should immunocompromised patients or those who will undergo immunosuppression receive zoster vaccine (ZOS)?
Should immunocompromised patients receive influenza vaccine?
Which vaccines should be administered to patients with primary (congenital) complement deficiencies?
Which vaccines should be administered to patients with phagocytic cell deficiencies (eg, chronic granulomatous disease [CGD], leukocyte adhesion deficiency, Chediak–Higashi syndrome)?
Which vaccines should be administered to patients with innate immune defects that result in defects of cytokine generation/response or cellular activation (eg, defects of the interferon-gamma/interleukin-12 [IFN-γ/IL-12] axis)?
Which vaccines should be administered to patients with minor antibody deficiencies?
Which vaccines should be administered to patients with major antibody deficiencies who are receiving immunoglobulin therapy?
Which vaccines should be administered to patients with combined immunodeficiencies?
Which inactivated vaccines should be administered to human immunodeficiency virus (HIV)-infected patients?
Should live vaccines be administered to HIV-infected patients?
Which vaccines should be given to patients with cancer?
Should hematopoietic stem cell transplant (HSCT) donors and patients be vaccinated before transplantation?
Which vaccines should be administered to adults and children after HSCT?
For adult and child SOT candidates and living donors, which vaccines should be administered during pretransplant evaluation?
Which vaccines should be administered to SOT recipients?
Which vaccines should be administered to patients with chronic inflammatory diseases maintained on immunosuppressive therapies?
Which vaccines should be administered to asplenic patients and those with sickle cell diseases?
Which vaccines should be given to individuals with cochlear implants or congenital dysplasias of the inner ear or persistent CSF communication with the oropharynx or nasopharynx?

Number of Source Documents: 484

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Vaccination of the Immunocompromised Host

Responsibility for Vaccination

Timing of Vaccination

Household Members (See Table 1)

Table 1. Safety of Administration of Live Vaccines to Contacts of Immunocompromised Persons

Influenza, live, attenuated nasal

MMR

Poliovirus, oral

Rotavirus, oral

Typhoid, oral

Varicella

Yellow fever

Zoster

International Travel

Specific Vaccinations

Varicella and Zoster Vaccines

Influenza

Special Populations

Primary (Congenital) Immunodeficiency Disorders

Primary Complement Deficiencies

Phagocytic Cell Deficiencies

Innate Cytokine or Cellular Activation Defects

Minor Antibody Deficiencies

Major Antibody Deficiencies in Patients Receiving Immunoglobulin Therapy

Combined Immunodeficiencies

HIV-Infected Adults, Adolescents, and Children (See Table 2)

Inactivated Vaccines

Live Vaccines

Table 2. Vaccination of Persons With HIV Infection

H. influenzaetype b conjugate

Hepatitis A

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Hepatitis Bd

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

DTaP

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Tdap

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Td

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

HPV4e

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Influenza, inactivated

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Influenza, live attenuated

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

MMR, live

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

MMRV, live

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Meningococcal conjugateg

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Pneumococcal conjugate (PCV13)

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Pneumococcal polysaccharide (PPSV23)j

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Poliovirus, inactivated

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Rotavirus, live

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Varicella, live

Low-Levela or No Immunosuppression

High-Level Immunosuppressionb

Zoster, live

Low-Levela or No Immunosuppression

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Hepatitis B^d

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

HPV4^e

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^aor No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Meningococcal conjugate^g

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Pneumococcal polysaccharide (PPSV23)^j

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Low-Level^a or No Immunosuppression

High-Level Immunosuppression^b

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a

Prior to or During Chemotherapy^a